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I '4 Date .�. ° �,a.. . . .. . . .. taORTpq TOWN OF NORTH ANDOVER Q tea. a �� „; A PERMIT FOR GAS INSTALLATION i CHU$ � . .This certifies that has permission for gas installation , , !< . . . . . . . . . . . . . . . . . in the buildings of � ��, . .,�� ��� . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . rT _ at .: :'. . . . . . . . . . . . . . . . . . . . . . . Tar h_Andover, amass. Fee... . . . . . . Lic. Ins. '. . . : . . h 0ASINSPECraR. .. Check## f i MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING uplCity/Town: t" m / �'� , MA. Date: .3 I Permit# Building Location: z ZOwners Name: Type of Occupancy: Commercial ❑ Educational ❑ Industrial ❑ Institutional ❑ Residential '`' New: ❑ Alteration: ❑ Renovation: ❑ Replacement: Plans Submitted: Yes ❑ No❑"' FIXTURES ui z I— u] U X W Q rn O ~ cn vi z w- z w fU ix O N r4 LU W g m O Q a Na W X WWZ l�il z O -' H F O z J C7 u_ N = w w w z } tr 0 Q Q w O z O fj > z _ UO t3 a U- 0 0 i � < O a0 < 0 Iw— z z > � O SUB BSMT. BASEMENT 1 FLOOR 2 FLOOR 3 FLOOR 4 FLOOR 5THFLOOR 6TH FLOOR 7 FLOOR 8 FLOOR Installing Company Name: 1 f}y ,� Check One Only Certificate# 2 ❑ Corporation Address: G 1 c -ill?Z"41Id Li. CitytTown. �'v,_ a �' State: ❑ Partnership Business Tel: Fax: rmlCompany Name of Licensed Plumber/Gas Fitter: - �. ,! f INSURANCE COVERAGE: �� I have a current liability insurance policy or its substantial equivalentwhich meets the requirements of MGL.Ch.142 Yeses No If you have checked Yes,please indicate the type of coverage by checking the appropriate box below. A liability insurance policy Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. Check One Only Owner ❑ Agent ❑ 5i nature of Owner or Owner's Agent By checking this box❑;I hereby certify that all of the details and information I have submitted(or entered)regarding this application are true and accurate to the best of my Knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State robing C de and Chapter 142"a General Laws. TYRO of License: By ETPIumber Title ❑ as Fitter Sig ature of Licensed Plumber/Gas Fitter aster cityrrown ❑Journeyman License Number: APPROVED OFFICE USE ONLY ❑ LP Installer Date. . . r i R°p aTOWN OF NORTH ANDOVER a . PERMITI S CHUs This Certifies that"". a has permission to perform . . . plumbing in the buildings of . . . . . . . . . . . . . . . . . . . . . . . at � f L . . . . . . . . . . . . . . .. North Andover, Mass. Fee. , . ". . . . .LIC. (1. � . . . �. �s'. �PLUMBING INSF�ItC7oR Check i i MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING y/ ' , Cit Town: �..r_ � ,. ( � ��'t-MA. Date: 3 1� �� Permit# Building Location: /lie„i-�J S - Owner -77 s Name: [ Type of Occupancy: Commercial❑ Educational❑ Industrial❑ Institutional❑ Residential 0' New: Alteration: ❑ ❑ Renovation:❑ Replacement:® Plans Submitted: Yes❑ No FIXTURES wvi of OTDEDICATEID A'S LU Gn O O Uj en T. w h a z F- w 4 s Wv1 x l9 ua aa,w m _ Q 'nFen 'v X U a x w J Z + U. o a zi Q x = 06 Oz zH vi.Oo 0O 00 Z ¢Q vi o =Q m m Cn LA Q SUB BSMT. BASEMENT 1sT FLOOR 2ND FLOOR 3RD FLOOR 4T"FLOOR 5Ts FLOOR 6T"FLOOR 7T"FLOOR ST"FLOOR VIf 6., Check One Only Certificate # Installing Company Name: �✓ i E ( L Address: .) o ' '' �'l �9 L( � e ❑Corporation � City/Town: I! State: �'��` -1 ❑Partnership Business Tel: Fax: irmlCompany Name of Licensed Plumber: INSURANCE COVERAGE: I have a current liability,insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 Yes E No❑ If you have chocked Yes,please indicate the type of coverage by checking the appropriate box below. A liability insurance policy Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. Check One Only ❑ Signature of Owner or Owner's Agent Owner ❑ Agent hereby certify that all of the details and information I have submitted(or entered)regarding this application are true and accurate to the pest of my Knowledge and that all plumbing work and installations performed under the permit issued for this ap ication will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and C ter 142 the General Law [City/Town y Type of License: tle ' P umber Signal re of Licensed Plumber Master PPROVED(OFFICE USE ONLY) I []Journeyman License Number: TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION D Permit NO: ate Received Date Issued, L I'� Tm Applicant must com Iete all items on thi -LOCA110. 2 r4 Print PROPERTY OWNER'IMY print MAP NO3_1 PARCEL- 110 Qel��L ZONING DISTRICT: 11istoric District yes Machine Shop Village yes no TYPE OF I VEMENT PROPOSED USE Residential Non- Residential 0 New Building n One family 0 Industrial EI Addition Ei Two or more family 11 Commercial El Alteration No. of units, El Repair, replacement ---a—Assessory Bldg 0 Others: 0 Other 11 Demolition .11❑ 1111-17��'�''lain Wetlands ( a Jzstrict .......... 17 I{ AEI It J DE I SCRIPTION OF WORK TO BE PERFORMED:, Mentifleation Please Type orRrint Clearly) Plionc:1-28' 59Y(-41S-� OWNER: Name: YM VeAL4%n Address .......... NO AA)Jov!�& CONTRACTOR Name: UVCAI 0 LLC' Phone: Ue"VP6Y7 Address j 11 Supervisor's Construction License: 5-fqY3 Exp. Date: I-Iome Improvement License: -7..3 3 ...j3xp. Date: /0 ARCH ITECTIENGINEER Phone: ............. Address: Reg. No. FEE SCHEDULE.,gULD1NGPERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BAqED ON$125,00PER S.F. Total Project OSt: 8— FEE: $ Receipt No.:_ Check No.. T erns co ate ctng with unregistered contractors do not have access to the gu4antyfund ery O R NOi Location No. Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ "ACHU Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL Check # 5 %, Building Inspector 2 4 fr TkORTH And 0VM Of over . 0 No. � 7_ e� dover, Mass., COC HICME WICK � - �OPATED PP� � BOARD OF HEALTH Food/Kitchen Septic System ijERMIT T D BUILDING INSPECTOR THIS CERTIFIES THAT [.1V'% ... ................ ... Foundation "........................ has permission to erect........................................ buildings on ........ �.... ............................. .... Rough Chimney to be occupied as.............. ' .....,................I............ .......... ................................................... himn y provided that the person accepting is permit shall in every respect confo to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIC AR ~S Rough _...................................................... Service BUILDING INSPECTOR Final Occupancy Permit Required to Ocatpy Building . GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final o Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the BuildingInspector. Burner Street No. S E REVERSE SIDE Smoke Det. MY, YF,Y5,,AIl�ab V1 C"'cb�k ... �k"JIFJ L411 Ardar7ga We hereby ya submit sraa'u¢F k,aVkarns and estimates fors f nr �' r f " Rip,a Rerna,nvc.n aalll shingle debris l`irrrrrn root,tt bait site Mtb out,O rn disposal trruck- r _ J I laayr it layers"� 3 layers or rrrcap "J lea-Spahr/ r Re`O a(,.e'an roof a,aralringe not� exceed q,ft (a� rtiorh ll�°� 1,7 per,TL) ke lnstati 8"an uii,u,m"rrhnrn drip-edge/and ral,(e-edge along enfire perirneter, Choice . of nruillt 215,Or brown F" lnarta"aH IltCE aye.WATER uunder°laayrrraent along i°oriaruntcai eves,valleys, sidew ll sky-lights and chirrineys T�r lnc tat panemiuurnn base sheet uuunderlaayunernt between meat deck and roofing diiingies irrvtaaltl Your choice unf�°f n�nbr�rVGwA or Il r Lifetime architecturaV roof shingles `gee rnaanuutaacctuurer warranty poHcy for rn un details J, ln„�t�ni�^ l newluunninuurn vent pipe fine°g(pl ,,,(, ) ............ ..... r .. , . .: UiYl Chimney(s) c anrtuntcar flasalhn aau nal re-step existing flashing t uat lu°wntlR uwr leadtiatnnun � w "u IJ a„ t cainbrrlu.aaauu lRir`lt ro.,.wrerit autpn=lcauw profile design, hidden by Shingle caps ntfpl-vnarntilntion CJ Roof inruver-vnntn .... k Searr°flesu aaluurninu,un't iturttnrs o.istorn fabricated at job criie by uur own guatter,machine y .......... DOW11SPOL S karat ffuutt r gUards Im�u�a Otp"na'au' Aff f i f i ,,,,,,,,,,,,..., i h ...... ...... . .............. ftA Ppcn.,n Iflrute; Ali itnnns kni roof attic ry hOUlb b urerncuved car covered due to tn.Rlln roof yu,nrfides, t time cat roof tear-off � .,N"n r.% �n Cm ry s ri ��� W � J t"Irice incula.des all terns above that are checked only f others irn°aany be priced separately upon ranrfuuest„ ' nu ar:wfan hereby to furnratn mu t�hail n p to r . � _wwww { (r o • c»garrnla„tn in aacac,rurctnc"ra wnritta nksravn specfficatocrins,for the suurnn ryt, rrrti I if r � .faaral Price not indudiirtg rstartaarsau. afca9lanrn( ...KL/ %� �F Paayrarrent to Ibe made as fi,aAlct s: 'tuk%cNaayuca,wst ruacyuuiraacV tcnf'care arrcavrlrg n°7rnaiarrwaurru, Balance ctuaau in fulB asperau c°taatr of c.;rumVallaat6uron, Plr aaS'6%Ally,"na4.l^r,aa 0 payments OUt to t enrrc,k,,t a t"lr.vaa.la rrrnaniled to: tP.0, Box 637, No. Reading, MA 01864 ............ .. ..... LAe charges gays of +;ytf per week,for all a auut,nttauruutnruc tally rlu,ie uq: ra day of Atithorized nc>nau ulrutrcarn, Sigimature, .., a;wcepii ng i.'rroix.-is,aal rrneaar7i,a agreeing to the terms cut the enclosed binder, Nole:°T his proposal ranaay bena:arntrarast, withdrawn Itay LIS If ruuai aceepted within �......� _. ......,d ys Nlassachusetts - Del►artment of Pt,I3lic Saf'etr Board of Building Re- ulations and Standards Construction Supervisor License License: CS 58443 Restricted to: 00 KENNETH P DUVAL PO BOX 190172 NORTH ST N READING, MA 01864 Expiration: 12/10/2011 ( onallisxi odic F. Tr#: 10475 r Office of Consumer Affairs&B siness Regulation HOME IMPROVEMENT CONTRACTOR Registration: _...167338 Type: Expiration 9/10/2012 LLC DWAL'ROOFING LtG KENNETH DUVAL 72 NORTH ST g NO. READING,MA 01864 Undersecretary NOTICE N NOTICE W TO 7 TO EMPLOYEES EMPLOYEES r I The Commonwealth of Massachusetts DEPARTMENT OF INDUSTRIAL ACCIDENTS 600 Washington Street, Boston, Massachusetts 02111 617-727--4900 — http://www.mass.gov/dia As required by Massachusetts General Law,Chapter 152, Sections 21, 22 &30, this will give you notice that I (we) have provided for payment to our injured employees under the above mentioned chapter by insuring with: THE TRAVELERS INSURANCE COMPANIES NAME OF INSURANCE COMPANY P .O. BOX 1450 MIDDLEBORO MA 02344-1450 ADDRESS OF INSURANCE COMPANY (7PJUB-0230N91 -9--1 1 ) 03-1 1 -1 1 TO 03-1 1 -12 POLICY NUMBER EFFECTIVE DATES W GILBERT INS AGCY 137 (RAIN ST REAPING MA 01 8G7 NAME OF INSURANCE AGENT ADDRESS PHONE# ^ . DUVAL ROOFING LLC 184 PARK STREET o NORTH READING d MA 01864 EMPLOYER ADDRESS EMPLOYER'S WORKERS COMPENSAVON OFFICER (IF ANY) DATE MEDICAL TREATMENT The above named insurer is required in cases of personal injuries arising out of and in the course of employment to furnish adequate and reasonable hospital and medical services in accordance with the provisions of the Workers' Compensation Act- A copy of the First Report of Injury must be given to the �- — injured employee. The employee may select his or her own physician_ The reasonable cost of the services provided by the treating physician will be paid by the insurer, if the treatment is necessary and reasonably connected to the work related injury_ In caScs requiring hospital attention, employees are hereby notified that the insurer has arranged for such attention at the NAME OF HOSPITAL ADDRESS TO BE POSTED BY EMPLOYER o01638 W20P1G02 The Commonwealth of'Massachusetts Print Form Department qf'Industrial Accidents r Office of lnvcstigati��r71s �f 1 Congress.Street, Suite 100 osto , . A 0211 -2017 IV Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers lia>rot Ie�fa�r atie� Please I'rigt L1ly Name (Busitr,ess/Organizatiott/individual'): � __. __.._ __._..-_....__._dam address: — _.__._. .,....._......-...--.._... City/State/Zip: Phone#:,--b 6_ ._!_ ._....__ Are you an employer? Check the dppropriate box: Type of project(required): 1. I am a employer with 4• 1 am a general contractor and I C. ®New construction employees(full and/or part-time).* have'hired the sub-contractors 10 1 am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling These sub-contractors have slip and have no employees8. ® Demolition workingfor me in acit employees and have workers' any capacity.y. 9. ® Building addition [No workers' comp,insurance comp insurance.l required.] 1. 5. We are a corporation and its 10. Electrical repairs or additions ❑ 3,El 1 any a homeowner doing all work officers have exercised their 11. P1 nbing repairs or additions myself. [No workers' comp right of exemption per M("IL 12. oof repairs insurance required.] t c. 1.52, §1(4), and we have no employees. [No workers' 13.® Other comp, insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers"compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then him outside contractors must submit a.new affidavit indicating such,, lC",ontractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. X am an employer that is providing g workers'compensation insurance fir rrryr emplgyees4 Below is the policy ar djob site i forr atiom Insurance Company Name: %-- Policy#/or Self-ins. Lie. ##: s° I' . Expiration Date:_ � ' Joky Site Address: City/State/Zip: _..m Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a. fine:up to$1,500.00 and/or-one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a clay against the violator. Be advised that a copy of this statement may be forwarder]to the Office of Investigations of the DIA for insurance coverage verification. I alga herebh certi' under the pains and penalties qfperjury that the irz arrmation provided above is true and cor^rect, Si rnatur : n/ Datt:' /t _ �✓ Phone##. iclal use only. Do not write in this area,to be completed by city or town ar,��acial. City or Town: Permit/License# Issuing Authority(circle one): 1.Berard of Health 2.Building Department 3. City/'Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#« Rom . Massachusetts Home IMRrovement Sawa le Contract This form satisfies all basic requirements of the state's Home Improvement Contractor Law(TvfGL chapter 1 g2A),but does not include standard language to protect homeowners, Seek legal advice if necessary. Any person planning home improvements should first obtain a copy of"A 4lassachusem Consumer Guide to Home Improvement"before agreeingto any work on your residence.You may obtain a free copy by calling the Office of Consumer Affairs and Business Regulations ConstnnerInfomation Hotline at 617-973-8787 or 1-888-283-3757 or on our website. Homeowner h-tfformation Contractor Information Name Campw.l�Name Sa9et}sideeas(dGnn use a Post mo�fice B(a address) Coatractwr Savpzrscsf lhcuer Name .r ' Cityg0"t State Zip Code Susmess. ens(roust include a street address) Dzy=: Phanz Evening Phone Cityf-b n e Zip Cade x$mi�cg?sld�s litdiff=m fmm abo,e, Bt-iD ss Phone Fcdtral Fssplay:r ID M S-S,idnmber A' � ��55 �� d✓ gg �y�% _� �' _ HvnL LW^_J/o:'NLt3 C'4AIdGMRtd�:`�.p E.�hVn di# a �el'� �m'V"�.✓ W�k a'°'�• A ']are rn4¢ass�[af masl3eme ray � ). .� y�,yq �5' q���a�qq bb,, �,^+may'/''� ✓ ipxglase¢r�tAAaln�oef$A5`t @$f/� P r�y� Y�$n'LjW +� °°s^W 5d'r"a.P L� A�'d 1E'.'3•'nfNA A41Ct[ 3 'M' 99 3 The Contractor agrees to do the fallowing work for the Homeowner: (Describe in detail the uurkto completed,spec-i.yi the type,brand and grade of materials to be used,we a = •.) Required Permits-The follos tog building permits are required Proposed Start and Completion Schedule-The fallowing schedule will and will be secazed by the contractor as the humeownefs agent: be.adhered to unless cinl-Lumances beyond the contractor's control arise (0,amers who secure their own permits Sri!!be 3 excluded from the GuarantyFund provisions of GmmDate when contractor will begin contracted work. LTGL chapter 142A.) " a,, 1 6 CA-,I ? ?•tea, �' Date when contracted work will be substdltially completed. I Tabd Contract Price and Payment Schedule The Comiactoz&,tees to perform the work finish the material and labor specified above for the total sum at- Payments will be made according to the following schedule; r upon signing contract(not to exceed W of the total contract price a the cost.of special order items,whichever is greater) S by or completion off S by_I _or upon completion of ;y4.,� A , S o upon completion ofthe contract_ (Law forbids demanding full payment until contract is completed to both party's satisfaction) The following maierial/equipmint must be special S to be paid far raderedhefcse the conuactedivattbegins m order —i-l�v to meet the emplerim scbedule.(-) S to be paid for NOTES:(-)Inchtding all finance charges('*)Iaw requires that any deposit or dmni-payment required by the cmamtor before work bins may. not exceed the preater of(a)one-third of the total contract price or(b)the actual cost of any special equipment or eustom made ruaterial which must be special ordered in advance to meet the completion schedule. L F.sgress Warranty-Is as express wnrsaty being provided by the contractor? ©Na'ErYes_601 terns of the t urranty mmst be attached to the contract) Subcontractors-The eomtractor agrees to be solely responsible for completion oftbe work described regardless of the actions of any third parrylsubcourractorutilized by the contractor. The contractor forrher agrees to be solely responsible for all payments to all subcontractors for And labor u d agrem= - Contracl Acceptance-Upon signiu&this document becomes a binding contract under lativ. Unless athemise noted within this document,the contract shall not imply that any lion or other security iuteresthas been placed on the residence. Review the following cautions and notices carefully-before signing this contract. a Don't be pressured into signing the contract.Take time to read and fully understand ir_ Ask questions if something is unclear. a Make sure the contractorhm a valid Rome Im umvemene Contractor Registrarion. The law requires must home and subcontractors to be registered ts§th the Director of Home Improvement Contractor Registration-You may inquire about contractor registration by writing to the Birettas at 30 Park Plana,Room 5170,Boston,MA 02116 or by calling 617-973-8787 or 888-283-3757. Does the contractor have insurance? Ask the Contractor for his insurance company information so that you can confirm coverage,or ask to see a copy of a"proof of insurance"document. Know your rights and responsibilities. Read the Important Information on the reverse side of this farts and get a copy of the Consumer Guide to the Home Improvement Contractor Law. You may cancel this agreement if a has been signed at aplace otber than the contractor's normal place ofbusiness,provided von notify the coutractorin%;Tiling at his,'hzr main office or branch office by ordinary mail posted,by telegram sent or by delivety,not later than midnight ache third business day following the signing of ibis agreement. See the attached notice of cancellation fort for an explanation of this right. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACESiii 7lsv identical tapirs rrtt6i gnawer nacre be eot�kaad and sigoeo'.pee copy shau3d porn the home .Thendrer copy shozv?d bakeptl>)•t3r,ecmmacWr ,� ,g homeowner •ZSi�marmwel ontractar's Signature Date Date Coukractor Artaftratiori The Horne Improverneni Contractof Law provides homeowners with the right to initiate an arbitration action(as an. allernati%e Wo coul-I at non)if they have a dispute witha contractor. The saine right is net automatically afCorded to a contraciou hoe%ever, The contractor vVroirld have to resolve any dispute he/she has with a homeowner in COUTI unless 170th parties agrec�to[lie Optional clause provided beloiv. This clause would give the Contractor the same right to arbitration as is afforded to the homeowner by the I lome Improverneril Contractor Law. The conn-actor,,.read flic fiorneowvricr hereby mutually agree in,advance that in the event the contractor has as dispute fl"s contract,the contractor May submit the dispute to a private arbitration firm whicli has been,approved by o�tLe iEixCcuvive Office ofConsurner Affairs and Business Regulation,and the consumer strafl be required k arbitration as ptovided In Massachusetts General Lav"s,;ira ter 142A. Z'0 IvC "t.,onty actor's Signature xOTICE: Th zu-amres ofthipames above apply only to the,agrecmtr�ufthe parties to alternative dispute The h orneowner may i it itiaw a It zmad,oc dispute resolution eve en-,xh ere,this section is["ot ;igmcd by the parties. Hoineowner's RNuht� A hom2o%vner's 6' -undar the Home Impro%on C eni Contractor Law(iYIGL chapter 142A)and other consumer w protection las(i.e.M GL chapter 93A)may not be waived in any way,eNen by ageenrent, llovvever,horueOwflelS may be excluded from certain rights if the contractor they choose is not properly registered as Prescribed by hm% Hourcowncrs who secure their own building permcits are automatically excluded frorn all Guaranty Fund provisions of the Horne Improvernern Contractor Law. The contractor is responsible for completing fire%vork as described,in a tinidy and workm an like manner, Horneowners,may be entitled to other specific legal rights if the contractor I,UaYautCOS or provides art eKpress warranty for worknianship or materials. ITI addition to guarantecs or wamnifies provided by the contractor,all goods sold in Massachusetts Cain,an implied%VarTaru_y ofmcl-chantability and filnesr Coi- a particular purpose, An enumeration of other matters on xvhich the homeowner and contractor lawfully agree ynaY be added to the terms o C the contract a,I one as they do not restrict a homeo"ner's basic consumer rights, Ifyouhave questions about your consurner/borneowner rights,contact the Consurner Infformation Hotline below). Excultion of Contrael The contract must be execuled in Llujiticloc and should not be sigmed until a copy ofall exhibits and referenced documents have been aaacbed. Parties are also advised not to sigm the document undi all Monk sections have been filled in or marked as void,deleted,or not applicable. One original sil-ned copy ofthe contract with attachments is to be giv en to the owner and the other kept by the contractor. Ally modification to the original contract must be in VTifina and agreed to by both paidies.Contracted work may not begin until both parties have received a fully executed cop),of the contract,and the three day rescission period has expired. Accelerated Payments A contractor may not'demand payments in advance of the dates specified on the payment schedule in cases where the honieowuer deems hurdhurselfw be financially insecure. Hwvever,in instances where a conixactor deems him/heiself to be financially insecure,the contractor may require that the balance of funds not yet due be placed in a joint escrow accoLiiitasaprcrequisitetocoritiiii.iin-.tliccontrcictcciwcvrIc. signatures ofboth patties, Additional Information If yore have general questions or need additional information about the flome Improvement Contsticlor Law or other consumer rights,or ifyou wish to obtain a free copy of "A Massachusetts Consumer Guide to Home hirproverrictit" contact: C'onsurner Information I fofline Off-we of Consuincr Affairs and Business Reg-ulation 10 Park P117a,Rw,)ni 5170,Boston,TMA 02116 617-973.8787,888-283.3737 or-visit the OCABR website at hw)�, x aiass.gjr,t ocpbb If you want to verify the registration of a contractor or if yin have questions or need additional information specifically about the contrit0or registration component oFfhe Home linproventent Contractor Law,contact: Director of Horne Improvement Contractor Registration Office of Consumer Affairs and Business Regulation 10 Park Plaza,Room 5170,Boston,MA 02116 611-973-8787,988-2833757 or visit the HIC website at ht.W, Go online to view the status of Horne Improvement Contractor's kleaistratiom ma us:h i wscc ,,,I c,i c� HSI q i..............---. For assistance with inforrilal mediation of disputes of to register formal complaints against a business,call: Cl'onRlmer Complaint Section Office of the Attorney General 617-727-8400 AND/OR Better Business Bureau 508-652-4800,508-755-2548 or 413-73 343114 Verhion TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION AT IONd TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A.ONE OR TWO FAMILY DWELLING G wOnly BUILDING PERMIT NUMBER: e"" DATE ISSUED: ;> ic Buildinp,Commiss,ioner/Inus for SDI uildings Date SECTION I-SITE INFORMATION L f Property Address: 1.2 Assessors Map acid Parcel Number: t s r. _ ........... -------- Map Number Parcel Number 1.3 Zonmi g lnfornnation. 1.4 Property Dimensions: zorien D-istrict Pr used Use f.ot Area sf _ lirorata e It 1.6 BUILDING SETBACKS Front Yard Side hard RearYard Required Provide II rind I- ovided Re Hired Provided 1.7'lafater Supply Mai:L.0 44h' 54,)'r'i, 1.3. Flood lone Information: 1.8 Sewerage Disposal System: L aeblao D Priwa&c C I "t j zone Outside Flood ZoneLI Municipal f] On Site Disposal System 2.1 Owner of Rec ord �,- Narne(Print) t Address for Service: Signature Telephone 2.2 Owner of Record: ___....._......._._._.,_._ _ _._.__..____ _. _,_. _....__._. __....._._.. 1'�ame F'rieat Address fsrr Service: Signature Telephone SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable 2-Licensed Construction Supervisor: ,..� °�° f ' :i " � � � l�t�� F � License NumberWn Addres. �� " ; ic pxpiratian..... ate "ignature Telephone ass 3.2 Registered Hoene improvernent C tractor Not Applicable 0 Company Name Registration plumber ru AddressA L/ -- -- S', ature �mm Tele.!none SECTION 4-WORKERS COMPENSATION(M.G.L C 152 § 25c(6) V oil _rs 7 F,; pensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the buildi SECTION 5 Descr Proposed'1 or°Pc a lrcclr aII a ficable Rew C:onsta ttr tion LI Ex B isting uilding 11 R Ej epaiT(S) Alteti s(s) 1-1 A,dil,7,, j r iol ion--- Accessory Bldg. F] Demolition F1 Other 11 Specify _Brief 55_escription of Proposed---Wo—rk:—..--'-- -—------- 0(DIF SE7CiT6N6-—EST—IMATE-5—C—ON—STRUCTION CO-STS- Estimated Cost(Dollar)to be te�LjffTLfrat L)Licant 1, Building Mu I ti E�i e r 2 Electrical (b) Fsthnated'Fotal Cost of C0118trLlCtion 3 7_1"'ILIT!ILI Building Pernut fee(a) X. (b) 4 Mechanical 5 Fire Protection 6 Total (1+2+3+4+5) E4:�Oh7ecLk,_N—umber SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT as Owner/Authorized Agent of sab' property ct proj_je Herebv -------------- -to act on My hehalf,in all matters relative to work authorized by this building pennitapplication. S4),nature of Owner Date SEEIGN 7b OWNER/AUTHORIZED AGENT DECLARATION _-'as OwneriAuthorized Agent OfSLI�j(_Xt properly Hereby declare that the statements and itil'on-nation on the foregoing application are tine mid accurate, to the best of my'knowlcolge and beliel, Print Naa-,,c t f, /A ecat Date NO. OF STORIJ S SIZE 13ASEIW_,'NTOR SIAB `elf I,,"0FFI,0OR TJIVff,1)ERS 3[ SPAN DINIF"NSIONS DIM11,'NSIONS OF POSTS 1)5N57_4,SJON4>(AI^ HFIGHTOF FOUNDAIION ITUCKNF.SS SG,�E 01, F001ING X C IS litill,I)ING T, INC, CONNECT[,])T0_RA__'1URAL—GASUNE f J J LOcatjOn C M1 � .ma yap MORr I)ateAO 0 TOWIV or Von rya A �� P lic,FOUn,japerrn,t ''— I'ler Farr,,! Check # � o l � i berl!CPl �r iti° H d��M.., J f f WON N V r''C r ry I ovm Of - , Andover �7 ® No. - 0 lover, Mass., CHIC 00ATe Q IT BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System Vol BUILDING INSPECTOR THISCERTIFIES THAT.........0,.;. i—P.. . ............... ..�42...�N...................................................... Foundation has permission to erect..A.0.t.4v.bci.............. buildings on . .T.... .......... .. ,...................... Rough 4!Ors � VMe V r W 1 wi DO4+s 4�0^S � � It Chimney to be occupied as............... .� .:.... .... ,��...............................................................................................,...................... provided that the person accepting this ermit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Co struction of Buildings in the Town of North Andover. & N FAA* �oor 3 �� �� PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION ST5 ELECTRICAL INSPECTOR �.e Rough ............................................................. Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wail To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. The Commonwealth of Massachusetts "` = Department of Industrial Accidents d office of Investigations w� Boston, Mass. 02111 Workers,Compensation Insurance Affidavit Name . Please Print dew � .. t Name:,: Location: µ. "�7 CiN 21 0V 4 t 47 1W Phone # I am a homeowner performing all work myself. ..w l am a sale proprietor and have no one working in any capacity am an employer providing workers' compensation for my employees working on this job. Com an name: Address Ci : Phone#: Insurance.Co. Policy Company name: Address Ci : Phone#: Insurance Co. Policv# Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of,a fine up to$1,500.00 andlor one years`imprisonment-as_well_as_civil..penaities.in.the form of-a_STOP WORK_ORD.ER,and_afine of.($100.0D)a day.against.me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. y certify p aitie f perjury that the information provided above is true and correct. ... `, f do hereby cart' u r t sins and Signature � '° ������ ��.. Date � �^ r" Phone# � .. Print name ' rt Official use only do not write in this area to be completed by city or town official' City or Town Permit/Licensing ® Building Dept ©Check if immediate response is required 0 Licensing Board Selectman's Office Contact person: Phone# Health Department ® Other North Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by IVIGL c 11, S 150 A. The debris will be disposed of in: (Location of Facility) Signature of Per�it Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector Propout s ��, � 'Il PARAMOUNT i6c_ VINYL SIDING & CARPENTRY P7SchoolStreet MA LIC #056858 Methuen, MA 01844 Reg #108659 (508) 794-9950 PROPOSAL SUBMITTED TO PHONE DATE STREET JOB NAME CITY, STATE AND ZIP CODE JOB LOCATION ARCHITECT DATE OF PLANS JOB PHONE We hereby submit specifications and estimates for: It shall be the obligation of the contract to obtain ail permits as the owner's agent;owners who secure their own construction-related permits or deal with unregistered contractors will be eluded from access to the guaranty fund. dollars ($ ) Payment to be made as follows: I All material is guaranteed to be as specified All work to be completed in a workmanlike manner according to standard practices.Any alteration or deviation from above specifica Au thorized tions involving extra costs will be executed only upon written orders,and will become an Signature extra charge over and above the estimate,All agreements contingent upon strikes,accidents or delays beyond our control,Owner to carry fire,tornado and other necessary insurance. -'-��J- Our workers are fully covered by Workmen's Compensation Insurance. withdrawn by us if not accepted within days. DO NOT SIGN THIS CONTRACT 1F and conditions are satisfactory and are hereby accepted. You are authorized E ARE ANY BLANK SPACES Aurp unre of 11ropaual—The above prices, specifications to do the work as specified. Payment will be made as outlined above. Gate of Acceptance: Ign re PARAMOUNT VINYL SIDING & CARPENTRY 7 School Street MA LIC#056858 Methuen, MA 01844 Reg #108659 (508) 794-9950 PROPOSAL SUBMITTED TO PHONE DATE STREET / JOB NAME LI�7 CITY, STATE AND ZIP CODE � JOB LOCATION r ARCHITECT DATE OF PLANS JOB PHONE We hereby submit specifications and estimates for: r0o MEE -1-1-1=e(X)-,Oc C,�-g,/Ljo Itzeaelc- 0, -r, Ira- t� 1 0 T:�, i kji>y0'L-CJ A, D ids¢ tFr f=J'AJ115il It shall be the obligation of the contractor to obtain all permits as the owner's agent;owners who secure their own co struction-related permits Or deal with unregistered contractors will be excluded from access to the guaranty fund. .)01'j r I � dollars($ t ) Payment to be made as follows: T IT 1,9 All material is guaranteed to be as specified. All work to be completed in a workmanlike _ manner according to standard practices. Any alteration or deviation from above specifica- Authorized r sue' tions involving extra costs will be executed only upon written orders,and will become an Signature extra charge over and above the estimate.All agreements contingent upon strikes,accidents or delays beyond our control. Owner to carry fire,tornado and other necessary insurance. Note:This proposal may be Our workers are fully covered by Workmen's Compensation Insurance. withdrawn by us if not accepted within days. Araptanre of xoposi j—The above prices, specifications DO NOT SIGN THIS CONTRACT IF and conditions are satisfactory and are hereby accepted. You are authorized = "WHERE ARE ANY BLANK SPACES to do the work as specified. Payment will be made as outlined above. U Date of Acceptance: PARAMOUNT OF l- -7 .� c G•1 4///f% K VINYL SIDING & CARPENTRY 7 School Street MA LIC #056858 1111171 r &Yl KXIC-4 5 Methuen, MA 01844 Reg#108659 (508) T94-9950 PROPOSAL SUBMITTED TO PHONE !� j DATE STREET q6 NAME CITY, STATE AND ZIP CODE J B LOCATION d A 1< 1 � ARCHITECT .,DATE OF PLANE ; � � �^� ,y JO ONE We hereby submit specifications and estimates for: V n ,� �r �)?P',0< ���� oCr��f,t tee - ro4A/ dotkw J hf ,je`j 07 r E-C4— ivi_ X 4�F� fAJSr.4�911eV �d�9l7 S �`a✓ 1! `,b 1 f M I It shall be the obligation of the contractor to obtain all permits as the owner's agent;owners who secure their own construction-related permits or deal with unregistered on ractor�s will�be excluded r�m access to,the guaranty f�d. ��� � 0 S Fa 0 "Y �/�, b dollars C$ }. Payment to be made as follows: k x J Nam' �� jLp�/�rl��r�,//� �'=Qi"�y �l�t' c+��r�E=f�' �f��'jyj- 3wJr��•� ©R L�Q tbe• "J go! All mater✓✓✓ial is guaranteed to be as specified. Alt work to be completed in a workman€ike manner according to standard practices.Any alteration or deviation from above specifica. Authorized tions involving extra costs will be executed on€y upon written orders, and will become an Signature extra charge over and above the estimate.All agreements contingent upon strikes,accidents or delays beyond our control.Owner to carry fire, tornado and other necessary insurance. Note:This proposal may be Our workers are fully covered by Workmen's Compensation Insurance. withdrawn by us if not accepted within days. Aurptax[rr of D —The above prices, specifications —,DO NOT SIGN THIS CONTRACT IF and conditions are satisfactory and are hereby accepted. You are authorized THERE ARE ANY BLANK SPACES to do the work as specified. Payment will be made as outlined above, 5ignatlu Date of Acceptance: - �— ly .. ANC C1F SU[LbIN N U k B�rthdate;, 170StI962 E �y� 62002 T ag =` E} . A � a9.au GAMS[ X PORCH p O po X O v 2.5 STORY N 0 a C M PORCH E 60.00 THIRD STREET 1994(c)Bosfon Survey Software PREPARED: 09-18-1996 SCALE.- 1 inch =20 feet CERTIFIED TO: FIRST BANKERS MORTGAGE the permanent structures are approximately located an the JOHN According to Federal Emergency Management Agency ,round as shown. They either conformed to the setback J. maps, the major improvements on this property fall in an equirements of the local zoning ordinances in effect at RUSSELL he lime of construction, or are exempt from violation en- s #38717 area designated as Zone C 'orccment action under M.G.L. Title Vil, Chapter 40 A, '?" Community Panel No: iection 7, and that there are no encroachments of major ! �� S. Effective Date. mprovements either way across property lines except as �Su z - �73 hown and noted hereon, NOTE; Zone C is areas of minlmal flooding(no shading). This designation Is not based on an elevation certificate. 40TE:This Is not a boundary or title insurance survey.This pla w s prepar acc rdance to proc ral and technical standards for Mortgage Loan Inspections as adopted 3y the Massachusetts Board of Reglstrallon of professional en I ers and I sury yors,250 CMR 6.05,and use for any other purpose is prohibited.This plan is not to be IGar1 f,%r rnr•n.rilnn mm—h—,teed d.,....d..,1— —�..�......�u�